Death Grip (32 page)

The
crucial document at
benzo.org.uk
is
The Ashton Manual,
or more precisely, Dr. Heather Ashton's three-chapter protocol, “Benzodiazepines: How They Work and How to Withdraw.” For benzoheads looking to quit, it's the Holy Bible. In it, Ashton promotes a gradual taper via Valium, as she writes, “… usually over a period of some months.” She recommends Valium because it has a much longer half-life (twenty to one hundred hours, and up to two hundred hours before the active metabolites leave the body) than the fast-acting benzos like Ativan, Klonopin, and Xanax. If you're on the fast-acting drugs, she recommends that you first switch over before you taper; as Ashton points out, this is because they “are eliminated fairly rapidly with the result that concentrations fluctuate with peaks and troughs between each dose.” You therefore need to take the fast-acting forms several times a day, with many people experiencing, as I have, interdose withdrawal, i.e., “a ‘mini-withdrawal,' sometimes a craving, between each dose,” as she writes. However, tapering via Valium facilitates a more gradual drop in blood level (“the blood level for each dose falls by only half in about 8.3 days,” writes Ashton) with which the body can more readily keep pace, letting your GABA receptors slowly come back online to minimize symptoms. As Ashton codifies it in her manual, with Valium you “obtain a smooth, steady and slow decline in blood and tissue concentrations of benzodiazepines so that the natural systems in the brain can recover their normal state.” Valium also comes in handy ten-, five-, and two-milligram pills, letting you customize doses.

I'm reading this at 1:00
A.M.
, eyes bright for the first time in months but my spirits also falling because I know that, having abused Valium in the past, I'll be hard-pressed to find anyone to prescribe it. (And anyway, precisely because of this abuse it might not work for me.) Then I find it: Schedule 7 in Ashton's high-dose timetables—“Withdrawal from alprazolam (Xanax) 4mg daily with diazepam (Valium) substitution.” According to this table, from my high point of four milligrams of Xanax/Klonopin, going at Ashton's suggested pace with a Valium switchover, I should have tapered over 62 to 115 weeks: one to two years, not the seven-odd months that brought me precipitously to this point. No wonder I feel so rotten. Confirmation of my misstep is found in chapter two: “Abrupt or over-rapid withdrawal, especially from high dosage, can give rise to severe symptoms (convulsions, psychotic reactions, acute anxiety states) and may increase the risk of protracted withdrawal symptoms.” I lived this firsthand back in 1996—I should have known!—though it seems odd that I should feel even sicker this time around. As I'll discover later on a Yahoo support group, likely because of that cold-turkey jolt and the subsequent years of on-again/off-again use, I've yo-yo'ed my nervous system around and set the stage for a most grueling final withdrawal, perhaps even a protracted one.

I Google “protracted benzo withdrawal” and end up at a now-defunct site called benzoliberty.com. “Benzos Aren't Us” is their motto, and the site incorporates a header graphic with the stars and stripes, an upbeat, spiritual tone, and links to tips and graphic creations by survivors. One section in particular catches my eye: “Old Timer Stories,” a list of thirty-one names hyperlinked to their respective tales. It is all there, my story as reflected by others: years on the drugs, a host of baffling, creeping, worsening problems like insomnia, agoraphobia, emotional blunting, bowel distress, depression, tinnitus, muscle weakness or spasms, and anxiety. Various attempts to quit, many of them cold turkey or close enough, often upon physicians' advice or at hospitals or detox centers. All hell breaking loose. A denial by the professionals that benzos have anything to do with the insanity, perhaps with more psychiatric drugs added to treat various red-herring diagnoses. And then months and sometimes years of illness before a gradual return to health. One story in particular stands out: that of “Rik.” Rik was placed on a low dose of Xanax, a drug to which he became “severely paradoxical” within twelve weeks. In his quest to get off, he writes, “I was in and out of four treatment centers, two mental hospitals and more doctors than I can count and at one year [off benzos] was so sick on the drugs I had to hire a live-in caretaker.” Rik rented an apartment one block from a hospital during his eight-month titration, preparing for what lay ahead. His first two years off benzos were the worst: He maxed out at only two hours of sleep per night and passed his days walking constantly, sometimes up to eight hours. Rik's nights “were passed screaming into a pillow or curled up in a fetal position rocking myself.” He bought police handcuffs to chain himself to the bed, so as not to commit suicide on the worst days. Rik describes this dark night of his soul: “I prayed to see the next sunrise and the tiny bit of reality the daylight brought.” He became immuno-compromised—cold and flu viruses persisted for months, and his liver felt poisoned “from all the drugs I took to stop the symptoms.” Rik experienced “hundreds of physical breakdowns due to the stress and lack of sleep, and was on a first-name basis with the local ER staff for years.”

This is way hardcore.

I cannot tell you how much Rik's story frightens me, because it so resembles my own. I'm not paradoxical like Rik, but like him I am weak in a way I never imagined possible. Even during my most fearful moments in the mountains, those ill-advised free solos or sprinting from a raging lightning storm above treeline, I've never felt so close to death. Right now, a falling leaf could fell me. On bad days, I wish one would. I'm so low that I
want
to die. My brain is winding down like an old pocket watch; I've passed that threshold at which life itself becomes worse than dying, at which the urge to suicide becomes the only clear and logical choice. More than once I've begged my father to “let me go” so I can wander off quietly to end it. But another part of me, the small, impenetrable kernel that represents my will to live, slogs along on autopilot. So I keep peeling away the drugs in hopes of someday returning to my true self.

Within two weeks I'm off Paxil and have halved my Ativan. Paxil is a terrible antidepressant to withdraw from, leaving you with tremors, hot flashes, nightmares, rebound depression, and strange, electric “brain zaps.” I pass my days on the duplex floor while Kasey is at work, kicking, sobbing, howling, and clutching Clyde. He's a lively Plott hound puppy, but manifests in this burgeoning psychosis as loose skin draped over greening bones. All is corruption; all is death. To break up the hours, Clyde and I take short walks under pig-iron skies. We shamble through late-autumn sleet and sheets of grauple blown by a stern north wind, the tarmac oily-wet beneath our feet, the corn-flake smell of decaying leaves rising from the gutters. The days dawn bleak and drear and lightless, each worse than the last. One day I end up at Dr. Porridge's office, and I tell him about the “Ashton Manual.” His response? One word: “Huh.” He expresses no interest in reading it, no interest in trying a switchover to Valium. Instead, he says that I'm at great risk now because I no longer have an antidepressant on board and that we must quickly find a solution. One drug he's mentioned in the past is Remeron (mirtazapine), and I've found a forum post somewhere in which a man mentioned successfully using Remeron to get off Klonopin. I bring it up, and we agree to try yet another pill.

Another good benzo site,
bcnc.org.uk
, didn't exist in 2005, but if it had I might have found this tidbit from one author about adding in antidepressants during withdrawal: “From a personal point of view the only antidepressant that I would advise against is mirtazapine … I have noticed many people having horrendous symptoms, which seem to last an extremely long time after discontinuation of this drug.” For me, Remeron is the last straw: I lose what few moorings remain. I call my parents daily, hourly, but can only groan, sob, and plead into the phone in subverbal snippets. More floor time, more clutching at Clyde. “Desperate” does not even begin to describe the situation. I return after two days to the psychiatrist's office, where he diagnoses more “mixed states” and urges me not to give up on this new drug, adding that perhaps we need to increase the Depakote. I am unable to form an opinion one way or the other. I simply can't think. I can't stand to be around anybody; I can't stand to be alone. Kasey gives up: I've worn her out. She will break up with me over the phone two weeks later, and I can't say I blame her. Finally my father flies out to collect me and bring me back to Johns Hopkins for my third and final hospitalization since September.

 

CHAPTER 10

Mountain men aren't supposed to dwell on adornments, on minutiae: the cartoon tablecloth pilgrims, the grinning tom turkeys on Dixie plates, the orange fork-and-spoon sets, the chocolate-brown napkins. But mountain men do not spend Thanksgiving locked in psychiatric wards either. They should be in the Utah desert climbing red sandstone spires or parallel-sided fissures up blank panes of rock. They should be down at Hueco Tanks, auguring in on razor crimps, heel-hooking above their heads, hucking dynos for distant potholes. They should be in Las Vegas, climbing two-thousand-foot flying buttresses of Aztec sandstone. But not here at Johns Hopkins, not in some airless big-city hospital with nary a rock in sight, unless it's been quarried for flagstone cladding.

I look down at tablecloth pilgrims, push mashed potatoes around the plate, weep openly before the other patients. No one notices. No one says anything. No one cares. This is par for the course on a ward. Tears, bags under the eyes, screaming fits, aimless shuffling, manic bromides, panic attacks, muteness—business as usual on the fourth-floor “Affective Disorders” unit in Meyer Building at Hopkins. It is sundown, when my symptoms are strongest. My father and his girlfriend came by during visiting hours but then had a proper Thanksgiving dinner elsewhere to attend. They came; they saw; they went. I eat with my fellow mentals. I'm thirty-four, a mountain man given to long days solo above treeline, on granite aiguilles raked by wind and grauple. To ascending ropeless up thousand-foot inclines of sandstone, racing my stopwatch as sweat pours into my eyes with each ragged pant. To clinging to the overhanging underbellies of limestone caves, swarming toward daylight. I'm a “tough guy” with twenty-two years in the mountains, bawling over cartoon turkeys. The fake turkey on the plate is a not-alive turkey; he wears a pilgrim hat and smiles even as he holds the musket that will be used to kill him. He's so cute, so happy and carefree, but he will soon be dead within his own cartoon universe. The turkey in my mouth is a dead turkey. A real dead turkey. Yanked from the coop, shipped off, and beheaded at some factory. Moist and easy to chew, but dead. I have killed them both. I have killed everyone. I have destroyed everything. I feel bottomless pity for myself and for anyone who's ever known me. I am the world's biggest fuckup.

Another patient's parents brought the feast in. I wipe away my tears and come back around long enough to thank them. Their son is Mark, a thin young man with dark hair: diagnosis, major depression. Mark sits rigidly in a plastic chair, adrift in a bizarre, sparkle-eyed catatonia while his mother tries to interest him in a flake of turkey. She gets it into his mouth; he chews automatically. When he speaks, which is rare, it's in a disconnected robot voice. Anemic Maryland sleet spatters the hospital's sealed, tinted, double-paned windows, dimming bruise hued with the day's end. We're in the dining area fifty feet—one-quarter of a ropelength—above the enclosed courtyard where the patients go to smoke. There's a lot of that on wards: smokers. Nervous, aimless, idle, compulsive, yellow-toothed smokers. The fluorescents buzz overhead. Their harsh glare separates me even more from reality. It will be this way for years: Fluorescent-lit industrial spaces, grocery stores, gyms, and offices will foment going-over-the-waterfall feelings of derealization (the sense that your surroundings aren't real; the world compressing into two dimensions and receding) and depersonalization (the feeling that you yourself aren't real). When DP/DR comes on, I will have to grab a fold of skin and pinch
hard
to confirm my very existence.

I cannot picture climbing again, I'm so amped with withdrawal and scared of just …
being.
The fear is with me—it
is
me—but outside me too. It often feels like some inchoate astral presence hurtles toward Earth, and all I can do is sit shivering, awaiting its arrival. It's worse when I sit still, when I'm not distracted by group therapy or a nurse taking my blood pressure or conversation with other patients about our diagnoses, our meds, about what led to this point. There's not much else to talk about on a psych ward, so you find this common ground. If I stop moving for more than five seconds the fear comes crashing down again. The worst thing is that it will never arrive; it is always traveling but never arriving, suspended in the air like that moment in a horror flick when the coed poises to pull back the shower curtain, looking for the killer.

At Hopkins, we comprise a unit of twenty patients. The ward is shaped like a rectangular racetrack, the day area and nurses' station at the center, the rooms leading off the halls. My first morning there, a psychiatry intern pulled a chair up to my bed and sat before me with his pen and notepad. I slumped against the wall, retelling my history. It took three hours. He and other staff then talked to my father, phoned my mother, my stepmother (my father's ex-wife), and my girlfriend to investigate any history of mania. I will give them that—Hopkins at least sorted out that I wasn't bipolar. No one among my inner circle could recall a manic episode or even such tendencies. Soon they have a med plan: The Depakote will be replaced by lithium. Once I begin asking around, I'll learn that almost everyone on the ward has been placed on lithium; it's like the leis with which you're garlanded at the Honolulu airport. A naturally occurring salt, lithium is an old-school, first-line treatment for bipolar disorder. It flattens you, neutralizes you, neuters your moods—it's a chemical straitjacket, an agent of control to keep the inmates fat and docile, all in the same whatever-the-fuck-happens-is-fine mood. The pill makes me feel heavy-limbed and spacey, swaying to and fro with
mal de débarquement
, my hands fluttering with the shakes. I will taper it as soon as I'm back in Colorado. You can become toxic on lithium; dehydration or an increased dose can elevate your blood levels and land you in a coma, or worse. And climbers can't always carry enough water with them up the rock. Later, my father and I will have a discharge meeting with the doctors and a social worker, and I'll point out that I don't want to be on lithium—that I can't risk becoming toxic in the mountains.